Review Keywords Men’s depression Masculinities John L. Oliffe, RN, MEd, PhD University of British Columbia, School of Nursing, 302-6190 Agronomy Road, Vancouver V6T 1Z3, Canada Melanie J. Phillips, BSc University of British Columbia, School of Nursing, 302-6190 Agronomy Road, Vancouver V6T 1Z3, Canada E-mail: oliffe@nursing.ubc.ca Received 18 March 2008 Revised 25 June 2008 Accepted 4 July 2008 Online 10 July 2008 Men, depression and masculinities: A review and recommendations John L. Oliffe and Melanie J. Phillips Abstract Fewer men than women are diagnosed with depression, although commentaries about men’s depression suggest that the lower reported rates may be due to the widespread use of generic diagnostic criteria that are not sensitive to depression in men, as well as men’s reluctance to express concerns about their mental health or access professional health care services. This article provides an overview of the connections between depression and masculinities and, based on that literature, recommendations are made for how we might better understand, identify and treat men’s depression in gender-sensitive ways. ß 2008 WPMH GmbH. Published by Elsevier Ireland Ltd. Introduction Depression is diagnosed on the basis of symp- tom patterns that significantly interfere with a person’s daily functioning, including a depressed mood and loss of interest or plea- sure in all, or nearly all, activities for a period of 2 weeks or more [1]. Common manifesta- tions include changes to appetite, weight, sleep, psychomotor activity, energy levels; feel- ings of worthlessness or guilt; difficulty think- ing, concentrating or making decisions; as well as recurrent thoughts of death or suicidal ideation [1]. Over the last decade, the rates for diagnosed depression have increased world- wide [2–5] and depression has become a serious public health concern that is associated with significant disease burden [2]. Collated world census data indicates a lifetime prevalence rate of 8–12%, ranging from a low of 3% in Japan to a high of 16.9% in the US [6]. Major depression is the fourth leading cause of disability world- wide, and is ranked as the second leading cause of disability for the 15–44 year age group for both sexes [7,8]. Depression also affects indivi- duals financially through lost income and, increased medication and health service costs [2], and results in significant reductions in quality of life [9,10]. Nearly 75% of those with major depression have recurrent episodes throughout their life [6]. People who experi- ence depression are also more likely to have co- morbidities, both psychiatric and physical, including anxiety disorders, stroke, cardiovas- cular disease, diabetes and epilepsy [6,2,11], and poorer overall prognoses have been reported among individuals who have chronic illness and concomitant depression [2,12]. Although the pathways to suicide are diverse and complex, strong linkages between severe depression and suicide have been described [11,13]. Approximately 850,000 people commit suicide each year [8], and an estimated 30–70% of suicide completers are afflicted with a mood disorder, most commonly major depression [14]. Comparatively, fewer men than women are diagnosed with depression and in developed countries the ratio is 2:1 [15,16]. However, commentaries about men’s mental health sug- gest that the lower reported rates may be due to the widespread use of generic diagnostic criteria that are not sensitive to depression in men [17–20], as well as men’s reluctance to express concerns about their mental health and access professional health care services [11,21–22]. Severe depression is known to sig- nificantly increase the risk for suicide, yet 194 Vol. 5, No. 3, pp. 194–202, September 2008 ß 2008 WPMH GmbH. Published by Elsevier Ireland Ltd.